Managerial Epidemiology
Helpm31990
Chapter10.pptxChapter 10: Strategies to Reduce Liability
Managing Physicians
Facilities may have liability when a physician is involved in malpractice
Respondeat superior
Ostensible agency
Corporate negligence
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Professional Practice Acts
Regulatory boards
Created by State legislation
Statute defines the scope of professional practice and specifies:
Composition of the board
Duties and powers to create rules for the professional practice
Licensure process
Continuing education requirements
Investigation and disciplinary actions
Professional Discipline
Regulatory Board will:
Investigate suspected misconduct
Prosecute confirmed misconduct, as appropriate
Take appropriate disciplinary action for confirmed misconduct
License revocation
License suspension
Fines
Referrals for professional assistance
Examples of Misconduct
Repeated acts of negligence
Incompetence
Aiding or abetting the unlicensed practice of medicine
Failure to comply with government rules/regulations
Exploitation of the patient for financial gain
Evidence of moral unfitness to practice medicine
Examples of Misconduct
Failure to maintain appropriate medical records
Abandoning or neglecting a patient
Harassing, abusing, or intimidating a patients
Ordering excessive tests or treatments
Unlawful use of controlled substances
Physical impairment of professionals
Health problems, disease, disability, psychiatric issues, and alcohol/chemical abuse
Symptoms of impairment
Making rounds late --complaints from staff
Inappropriate orders -- frequent accidents
Hostile behavior -- mood swings
Personal hygiene -- job changes
Neglected social commitments
Symptoms – p 243
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Sexual Harassment
Providers are in the unique position of power
Patient is dependent on the provider
Identifying Previous Misconduct
Licensing boards share information concerning adverse actions against providers across state lines
The Federation of State Medical Boards
National Practitioner Data Bank
Risk Managers should ensure that the facility hiring and credentialing policies include a procedure for checking the data banks
National Practitioner Data Bank
Designed to collect comprehensive data on adverse actions taken against health care practitioners, malpractice payments made and Medicare/Medicaid exclusions.
Insurance companies and hospitals are required to report to DHHS and state licensing boards any medical malpractice payments resulting from court judgments or settlements
Facilities are required to check the NPDB for all new medical staff and every two years for re-credentialing
4 classes of adverse actions requiring reporting
Those taken against a practitioner’s license by a state medical board
Those taken against a practitioner’s clinical privileges at a health care facility
Those taken against membership by a professional society
Those taken by Medicare/Medicaid and the DEA
National Practitioner Data Bank
Clinical Practice Guidelines
Systematically developed statements to assist practitioners and patient decisions about appropriate health care for specific clinical circumstances.
Private Initiatives
Government Initiatives
Worker’s Compensation
Medical Liability Insurers
Risk managers must not only be aware of clinical practice guidelines, but also the legal implications of ignoring them
Health professionals reviewing other like health professionals to assess:
Quality concerns
Hospital privileging decisions
Group practice membership decisions
Staff conduct
Professional isolation
Education
Peer Review
Liability Alternatives
Limit number of lawsuits
Control size of awards
Limit access of plaintiffs to the system
Removal of Malpractice Litigation from Judicial System
Several tort reform proposals recommend shifting malpractice litigation away from the judicial system
Administrative Agencies
Alternative Dispute Resolution
No-Fault Proposals
Under this type of system, adverse outcomes would be automatically compensated without lawsuits regardless of whether the outcomes resulted from negligence.
Accelerated Compensation Events
Enterprise liability
Other methods
Summary
Risk Managers must work with the healthcare professionals in terms of practice guidelines and peer review.
Proactive liability reduction can offer significant protection of the organization’s financial resources.
